多囊卵巢综合征女性性功能现状及性功能障碍的危险因素调查分析

doi:10.12280/gjfckx.20200771

摘要/Abstract

摘要：

目的:调查多囊卵巢综合征（polycystic ovary syndrome,PCOS）患者的性功能现状,探讨PCOS女性性功能障碍（female sexual dysfunction,FSD）的危险因素。方法:采用横断面研究方法,对首都医科大学附属北京妇产医院（我院）内分泌科2019年1—12月就诊的PCOS患者使用女性性功能指数（Female Sexual Function Index,FSFI）量表,并补充附加问题,年龄、身高、体质量、腰围、臀围、高雄激素临床表现、学历、职业分类、收入水平、避孕、怀孕意愿、生活及工作压力和有氧运动等多个可能影响女性性功能的因素进行问卷调查。结果:本次调查共发放946份调查问卷,回收有效问卷712份（75.26%）。PCOS患者的FSFI总分平均（24.19±2.87）分,取Cut-off 值为26.55分时,566例（79.49%）为FSD高风险者。选取各维度的最大值的33%为Cut-off值,阴道润滑障碍、性高潮障碍、性欲障碍、性交痛障碍、性唤起障碍和性满意度障碍的高风险者分别为67例（9.41%）、38例（5.34%）、19例（2.67%）、17例（2.39%）、12例（1.69%）和3例（0.42%）。多重线性回归分析显示,怀孕意愿、避孕、体质量指数（BMI）、高雄激素临床表现、年龄是PCOS女性性功能障碍的相关因素。结论:PCOS患者是FSD的高危人群,对于怀孕意愿、肥胖、高雄激素临床表现、年龄增加等危险因素应该予以重视和管理。

关键词: 性功能障碍, 生理性, 女性, 多囊卵巢综合征, 危险因素, 女性性功能指数量表

Abstract:

Objective: To investigate the sexual function in women with polycystic ovary syndrome (PCOS) and to explore their risk factors for sexual dysfunction. Methods: This cross-sectional study was performed with women with PCOS, who referred to Department of Gynecological Endocrinology, Beijing Obstetrics and Gynecology Hospital from January 2019 to December 2019. The Chinese version of FSFI (Female Sexual Function Index) was used to evaluate the sexual functions, with additional questions which may have relationship to sexual life were determined including age, height, weight, waist and hip circumference, clinical manifestations of hyperandrogenism, educational background, occupation, income level, contraception, desire for pregnancy, life and work stress and aerobic exercise. Results: A total of 946 PCOS women participated in the study and 712(75.26%) women were included in the analyses after screening. The mean total FSFI score was 24.19±2.87. According to FSFI definitions (cut-off score 26.55), 79.49% of women were at risk of FSD. Based on domain scores, according to an arbitrary score of 33% of the maximum score in each domain, 9.41%, 5.34%, 2.67%, 2.39%, 1.69% and 0.42% of women were considered at high risk of dysfunction for lubrication, orgasm, desire, pain, arousal, and satisfaction respectively. Desire for pregnancy, contraception, BMI, clinical manifestation of hyperandrogenism, and age were significantly associated with FSD in PCOS women by multiple linear regression analysis. Conclusions: PCOS patients are at high risks for FSD. Clinicians should pay attention to and manage these risk factors of FSD for PCOS women for long-term.

Key words: Sexual dysfunction, physiological, Femininity, Polycystic ovary syndrome, Risk factors, Female sexual function index

田玄玄, 阮祥燕, 杜娟, 鞠蕊, 程姣姣. 多囊卵巢综合征女性性功能现状及性功能障碍的危险因素调查分析[J]. 国际妇产科学杂志, 2021, 48(2): 230-234.

TIAN Xuan-xuan, RUAN Xiang-yan, DU Juan, JU Rui, CHENG Jiao-jiao. Investigation and Analysis of Sexual Function in Women with Polycystic Ovary Syndrome and Their Risk Factors for Sexual Dysfunction[J]. Journal of International Obstetrics and Gynecology, 2021, 48(2): 230-234.

图/表 3

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人口学及临床特征	n	百分比（%）	人口学及临床特征	n	百分比（%）	人口学及临床特征	n	百分比（%）
年龄			BMI			怀孕意愿
20~<25岁	84	11.79	<25 kg/m²	452	63.48	有	489	68.68
25~35岁	549	77.11	25~28 kg/m²	181	25.42	无	223	31.32
≥35岁	79	11.10	≥28 kg/m²	79	11.10	担心意外怀孕
学历			WHR			是	45	6.32
高中及以下	128	17.98	<0.8	242	33.98	否	667	93.68
大专及本科	466	65.45	0.8~1.0	368	51.69	生活及工作压力
硕士及以上	118	16.57	≥1.0	102	14.33	无和轻度	348	48.87
职业分类			多毛、痤疮和或脱发（Ferriman-Gallwey评分）			中度	284	39.89
体力劳动为主	127	17.84	多毛、痤疮和或脱发（Ferriman-Gallwey评分）			重度	80	11.24
体力和脑力劳动相当	305	42.84	无和轻度（<3分）	350	49.16	有氧运动
脑力劳动为主	280	39.33	中度（3~5分）	274	38.48	<1次/周	379	53.23
收入水平			重度（≥5分）	88	12.36	1~2次/周	298	41.85
<6 000元/月	142	19.94	避孕			≥2次/周	35	4.92
6 000~1.5万元/月	405	56.89	是	226	31.74
≥1.5万元/月	165	23.17	否	486	68.26

人口学及临床特征	n	百分比（%）	人口学及临床特征	n	百分比（%）	人口学及临床特征	n	百分比（%）
年龄			BMI			怀孕意愿
20~<25岁	84	11.79	<25 kg/m²	452	63.48	有	489	68.68
25~35岁	549	77.11	25~28 kg/m²	181	25.42	无	223	31.32
≥35岁	79	11.10	≥28 kg/m²	79	11.10	担心意外怀孕
学历			WHR			是	45	6.32
高中及以下	128	17.98	<0.8	242	33.98	否	667	93.68
大专及本科	466	65.45	0.8~1.0	368	51.69	生活及工作压力
硕士及以上	118	16.57	≥1.0	102	14.33	无和轻度	348	48.87
职业分类			多毛、痤疮和或脱发（Ferriman-Gallwey评分）			中度	284	39.89
体力劳动为主	127	17.84	多毛、痤疮和或脱发（Ferriman-Gallwey评分）			重度	80	11.24
体力和脑力劳动相当	305	42.84	无和轻度（<3分）	350	49.16	有氧运动
脑力劳动为主	280	39.33	中度（3~5分）	274	38.48	<1次/周	379	53.23
收入水平			重度（≥5分）	88	12.36	1~2次/周	298	41.85
<6 000元/月	142	19.94	避孕			≥2次/周	35	4.92
6 000~1.5万元/月	405	56.89	是	226	31.74
≥1.5万元/月	165	23.17	否	486	68.26

项目	$\bar{x}±s$	最大值	最小值	范围间距	FSD高风险/特定领域性功能障碍高风险[n（%）]
FSFI总分	24.19±2.87	32.5	10.4	22.1	566（79.49）
性欲	3.58±0.83	6.0	1.2	4.8	19（2.67）
性唤起	3.93±0.75	6.0	1.2	4.8	12（1.69）
阴道润滑	4.49±0.62	6.0	1.8	4.2	67（9.41）
性高潮	3.83±0.97	6.0	1.2	4.8	38（5.34）
性满意	4.32±0.78	6.0	1.2	4.8	3（0.42）
性交痛	4.04±0.84	6.0	1.2	4.8	17（2.39）

项目	$\bar{x}±s$	最大值	最小值	范围间距	FSD高风险/特定领域性功能障碍高风险[n（%）]
FSFI总分	24.19±2.87	32.5	10.4	22.1	566（79.49）
性欲	3.58±0.83	6.0	1.2	4.8	19（2.67）
性唤起	3.93±0.75	6.0	1.2	4.8	12（1.69）
阴道润滑	4.49±0.62	6.0	1.8	4.2	67（9.41）
性高潮	3.83±0.97	6.0	1.2	4.8	38（5.34）
性满意	4.32±0.78	6.0	1.2	4.8	3（0.42）
性交痛	4.04±0.84	6.0	1.2	4.8	17（2.39）

影响因素	赋值	B	SE	回归系数	t	P
怀孕意愿	无=0,有=1	-2.571	0.298	-0.576	-2.094	0.000
避孕	无=0,有=1	1.124	0.397	1.142	1.005	0.000
BMI	<25 kg/m²=0, 25~28 kg/m²=1, ≥28 kg/m²=2	-0.096	0.307	-0.904	-1.412	0.001
高雄激素临床表现（F-G评分）	<3分=0, 3~5分=1, ≥5分=2	-0.811	0.176	-0.351	-5.844	0.005
年龄	20~<25岁=0, 25~35岁=1, ≥35岁=2	-0.067	0.031	-0.361	-5.102	0.030